Abstract
Patient-oriented workflow refers to decoupling workflow from the personnel who work in formal settings and coupling it, instead, to the patient, who is at the center of all work and who spans all settings, formal and informal. Patient-oriented workflow provides a holistic perspective that can inform the design of health information technology, organizational design, implementation and evaluation efforts. Both qualitative and quantitative methods can be used to study patient-oriented workflow. In this chapter we presented the use of patient-oriented workflow in various settings including emergency departments, daily living environments, nursing homes and skilled home health care. To successfully redesign healthcare delivery, as well as design and implement HIT that can account for care across the entire patient journey, healthcare delivery must be examined as an integrated system of a longitudinal process rather than a cluster of discrete tasks/processes in isolated environments. Patient-oriented workflow can provide the needed integrated perspective.
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References
Abraham J, Reddy MC. Challenges to inter-departmental coordination of patient transfers: a workflow perspective. Int J Med Inform. 2010;79(2):112–22. https://doi.org/10.1016/j.ijmedinf.2009.11.001. [Published Online First: Epub Date].
Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. BMJ Qual Saf. 2016;25(7):509–17. https://doi.org/10.1136/bmjqs-2015-004315. [Published Online First: Epub Date].
Booth AO, Lowis C, Dean M, Hunter SJ, McKinley MC. Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals. Prim Health Care Res Dev. 2013;14(3):293–306. https://doi.org/10.1017/S1463423612000412. [Published Online First: Epub Date].
Brennan P, Casper G. Observing health in everyday living: ODLs and the care-between-the-care. Pers Ubiquit Comput. 2015;19(1):3–8. https://doi.org/10.1007/s00779-014-0805-0. [Published Online First: Epub Date].
Campbell R. The five rights of clinical decision support: CDS tools helpful for meeting meaningful use. J AHIMA. 2013;84(10):42–7.
Carayon P, editor. Handbook of human factors and ergonomics in health care and patient safety. 2nd ed. Boca Raton: CRC Press; 2012.
Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. 2006;15(Suppl 1):i50–8. https://doi.org/10.1136/qshc.2005.015842. [Published Online First: Epub Date].
Carayon P, Wetterneck TB, Hundt AS, et al. Evaluation of nurse interaction with bar code medication administration technology in the work environment. J Patient Saf. 2007a;3(1):34–42. https://doi.org/10.1097/PTS.0b013e3180319de7. [Published Online First: Epub Date].
Carayon P, Alvarado CJ, Hundt AS. Work design and patient safety. Theor Issues Ergon Sci. 2007b;8(5):395–428. https://doi.org/10.1080/14639220701193157. [Published Online First: Epub Date].
Chung J, Ozkaynak M, Demiris G. Examining daily activity routines of older adults using workflow. J Biomed Inform. 2017;71:82–90. https://doi.org/10.1016/j.jbi.2017.05.010. [Published Online First: Epub Date].
Clegg CW. Sociotechnical principles for system design. Appl Ergon. 2000;31(5):463–77.
Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc. 2004;52(11):1817–25. https://doi.org/10.1111/j.1532-5415.2004.52504.x. [Published Online First: Epub Date].
Doutcheva N, Shah MN, Borkenhagen A, et al. Process variances in older adults’ care transitions from emergency department to home: process breakdown versus process resiliency. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2017;61(1):565–66. https://doi.org/10.1177/1541931213601625. Published Online First: Epub Date].
Dziadkowiec O, Callahan T, Ozkaynak M, Reeder B, Welton J. Using a data quality framework to clean data extracted from the electronic health record: a case study. EGEMS (Wash DC). 2016;4(1):1201. https://doi.org/10.13063/2327-9214.1201. [Published Online First: Epub Date].
Elhauge E. The fragmentation of U.S. health care: causes and solutions. New York: Oxford University Press; 2010.
Fairbanks RJ, Bisantz AM, Sunm M. Emergency department communication links and patterns. Ann Emerg Med. 2007;50(4):396–406. https://doi.org/10.1016/j.annemergmed.2007.03.005. [Published Online First: Epub Date].
Gee JP. An introduction to discourse analysis: theory and method. New York: Routledge; 2014.
Holden RJ, Mickelson RS. Performance barriers among elderly chronic heart failure patients: an application of patient-engaged human factors and ergonomics. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2013;57(1):758–62. https://doi.org/10.1177/1541931213571166. [Published Online First: Epub Date].
Holden RJ, Schubert CC, Mickelson RS. The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. Appl Ergon. 2015a;47:133–50. https://doi.org/10.1016/j.apergo.2014.09.009. [Published Online First: Epub Date].
Holden RJ, McDougald Scott AM, Hoonakker PL, Hundt AS, Carayon P. Data collection challenges in community settings: insights from two field studies of patients with chronic disease. Qual Life Res. 2015b;24(5):1043–55. https://doi.org/10.1007/s11136-014-0780-y. [Published Online First: Epub Date].
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687. [Published Online First: Epub Date].
Karsh B-T. Clinical practice improvement and redesign: how change in workflow can be supported by clinical decision support. Rockville: Agency for Healthcare Research and Quality; 2009.
Karsh B-T, Alper SJ. Work system analysis: the key to understanding health care systems. In: Henriksen K, Battles J, Marks E, Lewin D, editors. Advances in patient safety from research to implementation. Rockville: AHRQ; 2005.
Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc. 2010;17(6):617–23. https://doi.org/10.1136/jamia.2010.005637. [Published Online First: Epub Date].
Kaufman DR, Pevzner J, Rodriguez M, et al. Understanding workflow in telehealth video visits: observations from the IDEATel project. J Biomed Inform. 2009;42(4):581–92. https://doi.org/10.1016/j.jbi.2009.03.012. [Published Online First: Epub Date].
Kobayashi M, Fussell SR, Xiao Y, Seagull FJ. Work coordination, workflow, and workarounds in a medical context. CHI. Portland: ACM Press; 2005. p. 1561–4.
Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203. https://doi.org/10.1001/jama.293.10.1197. [Published Online First: Epub Date].
Lim CJ, Kwong MW, Stuart RL, et al. Antibiotic prescribing practice in residential aged care facilities—health care providers’ perspectives. Med J Aust. 2014;201(2):98–102.
Malhotra S, Jordan D, Shortliffe E, Patel VL. Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform. 2007;40(2):81–92. https://doi.org/10.1016/j.jbi.2006.06.002. [Published Online First: Epub Date].
Marjamaa RA, Torkki PM, Hirvensalo EJ, Kirvela OA. What is the best workflow for an operating room? A simulation study of five scenarios. Health Care Manag Sci. 2008;12(2):142–6.
Moen A, Brennan PF. Health@Home: the work of health information management in the household (HIMH): implications for consumer health informatics (CHI) innovations. J Am Med Inform Assoc. 2005;12(6):648–56. https://doi.org/10.1197/jamia.M1758. [Published Online First: Epub Date].
Morrill HJ, Caffrey AR, Jump RL, Dosa D, LaPlante KL. Antimicrobial stewardship in long-term care facilities: a call to action. J Am Med Dir Assoc. 2016;17(2):183 e1–16. https://doi.org/10.1016/j.jamda.2015.11.013. [Published Online First: Epub Date].
Nagelkerk J, Reick K, Meengs L. Perceived barriers and effective strategies to diabetes self-management. J Adv Nurs. 2006;54(2):151–8. https://doi.org/10.1111/j.1365-2648.2006.03799.x. [Published Online First: Epub Date].
Ozkaynak M. Characterizing workflow in hospital emergency departments. Dissertation, University of Wisconsin-Madison; 2011.
Ozkaynak M, Brennan PF. Characterizing patient care in hospital emergency departments. Health Syst. 2012;1(2):104–17. https://doi.org/10.1057/hs.2012.14. [Published Online First: Epub Date].
Ozkaynak M, Brennan PF. Revisiting sociotechnical systems in a case of unreported use of health information exchange system in three hospital emergency departments. J Eval Clin Pract. 2013a;19(2):370–3. https://doi.org/10.1111/j.1365-2753.2012.01837.x. [Published Online First: Epub Date].
Ozkaynak M, Brennan P. An observation tool for studying patient-oriented workflow in hospital emergency departments. Methods Inf Med. 2013b;52(6):503–13. https://doi.org/10.3414/ME12-01-0079. [Published Online First: Epub Date].
Ozkaynak M, Brennan PF, Da H, et al. Patient-centered care requires a patient-oriented workflow model. J Am Med Inform Assoc. 2013;20(e1):e14–6. https://doi.org/10.1136/amiajnl-2013-001633. [Published Online First: Epub Date].
Ozkaynak M, Dziadkowiec O, Mistry R, et al. Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records. J Biomed Inform. 2015;57:386–98. https://doi.org/10.1016/j.jbi.2015.08.018. [Published Online First: Epub Date].
Ozkaynak M, Unertl KM, Johnson SA, Brixey JJ, Haque SN. Clinical workflow analysis, process redesign, and quality improvement. In: Finnel J, Dixon B, editors. Clinical informatics study guide. New York: Springer International Publishing; 2016a. p. 135–61.
Ozkaynak M, Jones J, Weiss J, Klem P, Reeder B. A workflow framework for health management in daily living settings. Stud Health Technol Inform. 2016b;225:392–6.
Ozkaynak M, Valdez RS, Holden RJ, Weiss J. Infinicare framework for an integrated understanding of health-related activities in clinical and daily-living contexts. Health Syst. 2018a;7(1):66–78.
Ozkaynak M, Wu DTY, Hannah K, Dayan PS, Mistry RD. Examining workflow in a pediatric emergency department to develop a clinical decision support for an antimicrobial stewardship program. Appl Clin Inform. 2018b;9(2):248–60.
Ozkaynak M, Reeder B, Drake C, Ferrarone P, Trautner B, Wald H. Characterizing workflow to inform clinical decision support systems in nursing homes. Gerontologist. 2018c. https://doi.org/10.1093/geront/gny100. Published Online First: Epub Date].
Rogers A, Kennedy A, Nelson E, Robinson A. Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness. Qual Health Res. 2005;15(2):224–39. https://doi.org/10.1177/1049732304272048. [Published Online First: Epub Date].
Ross SE, Schilling LM, Fernald DH, Davidson AJ, West DR. Health information exchange in small-to-medium sized family medicine practices: motivators, barriers, and potential facilitators of adoption. Int J Med Inform. 2010;79(2):123–9. https://doi.org/10.1016/j.ijmedinf.2009.12.001. [Published Online First: Epub Date].
Rowe BH, Spooner C, Ducharme F, Bretzlaff J, Bota G. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1). https://doi.org/10.1002/14651858.CD002178. [Published Online First: Epub Date].
Sarkar U, Bates DW. Care partners and online patient portals. JAMA. 2014;311(4):357–8. https://doi.org/10.1001/jama.2013.285825. [Published Online First: Epub Date].
Shaffer DW, Hatfield D, Svarovsky G, et al. Epistemic Network Analysis: a prototype for 21st century assessment of learning. Int J Learn Media. 2009;1(2):33–53.
Shaffer DW, Collier W, Ruis AR. A tutorial on epistemic network analysis: analyzing the structure of connections in cognitive, social, and interaction data. J Learn Anal. 2016;3(3):9–45.
Sittig DF, Singh H. A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care. 2010;19(Suppl 3):i68–74. https://doi.org/10.1136/qshc.2010.042085. [Published Online First: Epub Date].
Stokoe A, Hullick C, Higgins I, Hewitt J, Armitage D, O’Dea I. Caring for acutely unwell older residents in residential aged-care facilities: perspectives of staff and general practitioners. Australas J Ageing. 2016;35(2):127–32. https://doi.org/10.1111/ajag.12221. [Published Online First: Epub Date].
Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006;13(2):121–6. https://doi.org/10.1197/jamia.M2025. [Published Online First: Epub Date].
Unertl KM, Weinger MB, Johnson KB, Lorenzi NM. Describing and modeling workflow and information flow in chronic disease care. J Am Med Inform Assoc. 2009;16(6):826–36. https://doi.org/10.1197/jamia.M3000. [Published Online First: Epub Date].
Unertl KM, Johnson KB, Gadd CS, Lorenzi NM. Bridging organizational divides in health care: an ecological view of health information exchange. JMIR Med Inform. 2013;1(1):e3. https://doi.org/10.2196/medinform.2510. [Published Online First: Epub Date].
Valdez RS, Holden RJ, Novak LL, Veinot TC. Transforming consumer health informatics through a patient work framework: connecting patients to context. J Am Med Inform Assoc. 2015a;22(1):2–10. https://doi.org/10.1136/amiajnl-2014-002826. [Published Online First: Epub Date].
Valdez RS, Holden RJ, Novak LL, Veinot TC. Technical infrastructure implications of the patient work framework. J Am Med Inform Assoc. 2015b;22(e1):e213–e15. https://doi.org/10.1093/jamia/ocu031. [Published Online First: Epub Date].
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78. https://doi.org/10.1377/hlthaff.20.6.64. [Published Online First: Epub Date].
Walker JM, Carayon P. From tasks to processes: the case for changing health information technology to improve health care. Health Aff (Millwood). 2009;28(2):467–77. https://doi.org/10.1377/hlthaff.28.2.467. [Published Online First: Epub Date].
Wang CC. Photovoice: a participatory action research strategy applied to women’s health. J Womens Health. 1999;8(2):185–92.
Werner NE, Gurses AP, Leff B, Arbaje AI. Improving care transitions across healthcare settings through a human factors approach. J Healthc Qual. 2016;38(6):328–43. https://doi.org/10.1097/JHQ.0000000000000025. [Published Online First: Epub Date].
Werner NE, Malkana S, Gurses AP, Leff B, Arbaje AI. Toward a process-level view of distributed healthcare tasks: medication management as a case study. Appl Ergon. 2017a;65:255–68. https://doi.org/10.1016/j.apergo.2017.06.020. [Published Online First: Epub Date].
Werner NE, Stanislawski B, Marx KA, et al. Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms. Appl Clin Inform. 2017b;8(1):191–205. https://doi.org/10.4338/ACI-2016-07-RA-0122. [Published Online First: Epub Date].
Werner NE, Tong M, Borkenhagen A, Holden RJ. Performance-shaping factors affecting older adults’ hospital-to-home transition success: a systems approach. Gerontologist. 2019;59(2):303–14. https://doi.org/10.1093/geront/gnx199. [Published Online First: Epub Date].
Woda A, Belknap RA, Haglund K, Sebern M, Lawrence A. Factors influencing self-care behaviors of African Americans with heart failure: a photovoice project. Heart Lung. 2015;44(1):33–8. https://doi.org/10.1016/j.hrtlng.2014.09.001. [Published Online First: Epub Date].
Wooldridge AR, Carayon P, Shaffer DW, Eagan B. Quantifying the qualitative with epistemic network analysis: a human factors case study of task-allocation communication in a primary care team. IISE Trans Healthcare Syst Eng. 2018;8(1):72–82. https://doi.org/10.1080/24725579.2017.1418769. [Published Online First: Epub Date].
Xie A, Gurses AP, Hundt AS, Steege L, Valdez RS, Werner NE. Conceptualizing sociotechnical system boundaries in healthcare settings:within and across teams, organizations, processes, and networks. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2016;60(1):866–70. https://doi.org/10.1177/1541931213601198. Published Online First: Epub Date].
Yen PY, Bakken S. Review of health information technology usability study methodologies. J Am Med Inform Assoc. 2012;19(3):413–22. https://doi.org/10.1136/amiajnl-2010-000020. [Published Online First: Epub Date].
Yen K, Gorelick MH. Strategies to improve flow in the pediatric emergency department. Pediatr Emerg Care. 2007;23(10):745–9; quiz 50–1. https://doi.org/10.1097/PEC.0b013e3181568efe. [Published Online First: Epub Date].
Zheng K, Haftel HM, Hirschl RB, O’Reilly M, Hanauer DA. Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective. J Am Med Inform Assoc. 2010;17(4):454–61. https://doi.org/10.1136/jamia.2010.004440. [Published Online First: Epub Date].
Zheng K, Guo MH, Hanauer DA. Using the time and motion method to study clinical work processes and workflow: methodological inconsistencies and a call for standardized research. J Am Med Inform Assoc. 2011;18(5):704–10. https://doi.org/10.1136/amiajnl-2011-000083. [Published Online First: Epub Date].
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Ozkaynak, M., Ponnala, S., Werner, N.E. (2019). Patient-Oriented Workflow Approach. In: Zheng, K., Westbrook, J., Kannampallil, T., Patel, V. (eds) Cognitive Informatics. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-030-16916-9_9
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